ORGANIZED EFFICIENCY IN A DISORDERED MEDICAL SETTING: THE AMERICAN AMBULANCE IN BESIEGED PARIS, 1870-1871 Gregory Seltzer A Thesis Submitted to the University of North Carolina Wilmington in Partial Fulfillment of the Requirements for the Degree of Master of Arts Department of History University of North Carolina Wilmington 2009 Approved by Advisory Committee William J. McCarthy Paul A. Townend Michael M. Seidman Chair Accepted by Dean, Graduate School TABLE OF CONTENTS ABSTRACT .................................................................................................................................. iii ACKNOWLEDGEMENTS............................................................................................................iv DEDICATION.................................................................................................................................v INTRODUCTION- THE FRANCO-PRUSSIAN WAR, THE RED CROSS, AND THE HISTORIOGRAPHIES OF THE AMERICAN AMBULANCE, FRANCE’S AID SOCIETY, AND FRENCH MILITARY MEDICINE.......................................................................................1 CHAPTER 1- THE DEFICIENT PREPARATIONS OF BOTH THE FRENCH ARMY MEDICAL CORPS AND THE FRENCH AID SOCIETY BEFORE 1870.................................16 CHAPTER 2- MEDICAL DISORDER AND THE SANITARY DISASTER IN BESIEGED PARIS............................................................................................................................................41 CHAPTER 3- THE AMERICAN AMBULANCE: SUCCESS FROM EFFICIENT ORGANIZATION.........................................................................................................................66 AFTERWORD- POSTWAR REFORMS IN FRANCE AND THE LIMITED INFLUENCE OF THE AMERICAN AMBULANCE.............................................................................................100 WORKS CITED ..........................................................................................................................109 ii ABSTRACT The American ambulance, which toiled in besieged Paris from the fall of 1870 until the spring of 1871, was one of the most acclaimed medical facilities of the Franco-Prussian War. This study addresses why the American ambulance garnered such widespread approval during this conflict, and the answer to this question reveals as much about the French medical services in 1870 and 1871 as it does about the American ambulance itself. This work argues that the consistent praise for the American ambulance resulted from the disparity between the sanitary conditions, organization, and surgical success of the American facility and those of the majority of French hospitals and ambulances laboring during the Franco-Prussian War. In contrast to the American ambulance, the French-sponsored medical facilities were disorganized and unprepared for the evacuation and treatment of the wounded. This study will demonstrate that neither the French army medical corps nor France’s Red Cross society was prepared to manage the medical stresses of a major conflict, and this lack of preparation contributed significantly to the sanitary disaster on the battlefields and in besieged Paris in 1870 and 1871. While the long-term medical influence of the American ambulance was limited, the historical contribution of this ambulance relates to its illustrating the deficiencies—and the wartime consequences of these deficiencies— of certain organizations that France’s government targeted in the years of reform following the Franco-Prussian War. iii ACKNOWLEDGEMENTS Many individuals have helped me in various ways with this project, including Rob Morrison, Dr. Philip Katz, Dr. Whitney Walton, and the staff at the National Library of Medicine in Bethesda, Maryland. I would especially like to thank Dr. Michael Seidman, who has provided me with invaluable guidance and practical advice for this thesis and since my first semester as a graduate student. I would also like to thank Dr. Bill McCarthy for challenging me to develop my ideas and for always having witty comments. Finally, I want to thank Dr. Paul Townend for his detailed suggestions and willingness to assist me with this study. iv DEDICATION I dedicate this thesis to my parents, Stephen and Marlene Seltzer, who have stood behind me with love and unwavering support in my decision to pursue my interest in French history. v INTRODUCTION- THE FRANCO-PRUSSIAN WAR, THE RED CROSS, AND THE HISTORIOGRAPHIES OF THE AMERICAN AMBULANCE, FRANCE’S AID SOCIETY, AND FRENCH MILITARY MEDICINE In 1970 Valentine A. J. Swain, the Senior Surgeon at London’s Queen Elizabeth Hospital for Children, wrote, “Though the military, political, and strategic aspects of the Franco-Prussian War have been fully recorded [,] little attention has been given to the medical side of this bitter struggle.”1 Although not as applicable today, Swain’s comment is valid with respect to detailed studies of the American ambulance. This service, which toiled in besieged Paris from the fall of 1870 until the spring of 1871, was one of the most acclaimed medical facilities of the Franco- Prussian War. This study addresses why the American ambulance garnered such widespread approval during this conflict, and the answer to this question reveals as much about the French medical services in 1870 and 1871 as it does about the American ambulance itself. This work argues that the consistent praise for the American ambulance resulted from the disparity between the sanitary conditions, organization, and surgical success of the American facility and those of the majority of French hospitals and ambulances laboring during the Franco- Prussian War. In contrast to the American ambulance, the French-sponsored medical facilities were disorganized and unprepared for the evacuation and treatment of the wounded. This study will demonstrate that neither the French army medical corps nor France’s Red Cross society was prepared to manage the medical stresses of a major conflict, and this lack of preparation contributed significantly to the sanitary disaster on the battlefields and in besieged Paris in 1870 and 1871. While the long-term medical influence of the American ambulance was limited, the historical contribution of this facility relates to its illustrating the deficiencies—and the wartime 1 Valentine A.J. Swain, “Franco-Prussian War 1870-1871: Voluntary Aid for the Wounded and Sick,” British Medical Journal 3 (1970): 511. consequences of these deficiencies—of certain organizations that France’s government targeted in the years of reform following the Franco-Prussian War. The American ambulance exemplifies Jean de Blonay’s conclusion that the war’s surgical results “allowed, above all, the bringing to light [of] the French health care system’s shortcomings as well as the beginning ills of the Red Cross societies.”2 In 1870 the term “ambulance” had a less exclusive meaning than its present-day definition. Bertrand Taithe indicates that the term “ambulance” had “the double meaning of [a] wagon or carriage designed to transport wounded patients, and that of an improvised field hospital usually of more than six beds.”3 Caroline Moorehead provides a broader definition for a nineteenth-century ambulance: “Anything from a single cart collecting the wounded, to field hospitals, first-aid stations, buildings given over to temporary hospitals and entire self-sufficient medical units, with surgeons, priests, nurses, carriages, horses, and all food and medical supplies. They could move or stay still and consisted of buildings, vehicles or groups of people.”4 To distinguish between the vehicle used to transport the wounded and the temporary medical facility, the term “ambulance” will refer only to a temporary hospital containing at least six beds in the current study. On 19 July 1870 France’s Emperor Napoleon III declared war on Prussia. France suffered its first major defeats in early August, and on 2 September Napoleon III surrendered to the Prussian forces at Sedan. News of the Emperor’s capitulation reached Paris the following day, and on 4 September the city’s republican deputies announced the fall of the Second Empire 2 Jean de Blonay, 1870: une révolution chirurgicale: les origines et le développement de la chirurgie civile et militaire moderne (Vevey: Éditions Delta, 1976), 133. Except for secondary sources of quotation, all translations are mine. 3 Bertrand Taithe, Defeated Flesh: Medicine, Welfare, and Warfare in the Making of Modern France (Lanham, Md.: Rowman and Littlefield, 1999), 74, n. 18. 4 Caroline Moorehead, Dunant’s Dream: War, Switzerland and the History of the Red Cross (New York: Carroll and Graf Publishers, 1999), 67. 2 and the formation of the Third Republic. As Melvin Kranzberg notes, however, “The defeat at Sedan did not mean the end of the war; it merely meant the closing of one phase of the campaign and the opening of another.”5 This second phase of the Franco-Prussian War was the siege of Paris, which began when the Prussians completed their encirclement of the French capital on 19 September 1870. Prior to this date, Paris increasingly took the form of what one ambulance surgeon referred to as a “giant hospital,” in which private residences, hotels, theaters, and government buildings became ambulances and hospitals.6 The French forces attempted three disastrous sorties from Paris during the siege, suffering 12,000 casualties following the Champigny sortie of 30 November, 983 after the Le Bourget sortie of 21 December, and 8,000 following the Buzenval sortie of 19 January